Trauma Surgery

Trauma surgery is enhanced type general surgery that includes treating those injured in car accidents, bicycle or motorcycle accidents, trips and falls, skiing or snowboarding accidents, as well as many other unforeseen activity-related injuries.

We specialize in trauma surgeries, such as:

Abdominal trauma

Patients with severe abdominal trauma may require surgery to fix uncontrollable bleeding or injury to the internal organs (liver, spleen, kidneys, pancreas, intestines, etc.). Some patients may have injuries to solid organs (liver or spleen) which does not require surgery, but does require close monitoring in the hospital and follow up for a couple months after the injury.

Blunt abdominal trauma is regularly encountered in the emergency department. Victims of blunt trauma often have other injuries as well. Blunt abdominal trauma most often results from car/ bike/ motorcycle accidents, pedestrians hit by a vehicle, direct blow to the belly (hit, kicked, tackles in contact sports), and falls (from height or from standing).

The spleen is the most commonly injured organ, followed by the liver and kidneys. Less commonly, the gastrointestinal tract (the intestines) can be injured as well.

In car accidents, passengers wearing a lap-belt without a shoulder attachment can suffer injury from the seatbelt forcefully compressing the abdomen. Tearing forces created by sudden stopping can cause injuries of both solid organs (liver, spleen, kidneys) and hollow organs (intestines) at their points of attachment to the abdominal cavity.

Unrestrained (not wearing a seatbelt) victims are at higher risk of injury than those who are restrained (wearing a seatbelt)

Diagnostic tests

A variety of diagnostic tests can be used to determine abdominal injuries including:

An ultrasound of the abdomen, usually performed in the Emergency Room, to determine if there is blood in the abdominal cavity.

A CT scan of the chest and abdomen which looks at the bones and the soft tissues.

Chest trauma

Chest trauma includes fractures of the ribs and/or sternum (breast bone), or sometimes severe bruising to the chest without fractures. This can be very painful and may require treatment in the hospital. This may also require surgery to remove blood or air from the chest cavity, or to fix the fractures.

General trauma

As general surgeons, we also oversee all patients that are injured (trauma) and seen at Good Samaritan Medical Center, including anything from a minor fall to multiple severe injuries from a high-speed motorcycle accident, and everything in between. Some of these injuries may require surgery, sometimes from a general surgeon or sometimes from specialist surgeons (such as neurosurgeon or orthopedic surgeon; some injuries do not require surgery but may still require treatment in the hospital and close follow up, depending on the type and severity of injuries.

<>Surgical Care

To help our patients heal faster and more completely, we approach treatment as a team effort so that you are totally confident in our plan for treatment and surgery if necessary.We routinely provide surgical care for:

Surgery for thoracic trauma

Surgery for Pneumothorax or hemothorax: If a chest tube is not enough to remove the air or blood in the chest cavity, your doctor might need to do surgery. This surgery is called “thoracoscopy (meaning a scope in the chest) or VATS (Video-assisted Thoracic Surgery).” This is “minimally invasive surgery” of the chest, similar to laparoscopic surgery of the belly.

During thoracoscopy, the doctor will give you medicine to make you sleep; it will be done under general anesthesia. Then he or she will make 2 or 3 small cuts between the ribs in your chest. He or she will put long, thin tools in these openings and into the space where the air collected. One of the tools has a camera on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to do the surgery.

Sometimes this cannot be completed using thoracoscopy, and in some cases it will require open chest surgery (this is called thoracotomy) to clean out the fluid in your chest.

Risks of Chest Surgery Include (but not limited to):

Bleeding

Infection in the chest or wounds

Injury to the lungs or heart, or other important structures in the chest

Need for further surgery or other procedures

Recovery after Chest Surgery for Trauma

After surgery you will have one or more chest tubes in your chest to continue draining the fluid. You will need to stay in the hospital for 3-7 days, or more, as you recover. You will need to stay in the hospital while the chest tube is in place. The chest tube will be followed by examination and Chest X-rays.

You will be sore for several weeks. Your doctor will also recommend a treatment to help prevent your small airways from closing off. This treatment, called “incentive spirometry,” involves breathing deeply into a hand-held device a number of times each day. It is also very important that you do not stay in bed. Activity, such as walking, although it can be painful, is very important to keep good lung function and to prevent pneumonia. When you are sent home from the hospital, you should walk around your house several times per day, and increase your activity as you can tolerate.

**You should also ask your doctor when you can fly in an airplane again. You will generally need to wait at least 2 weeks, and up to 12 weeks, before flying in an airplane or traveling to areas of elevation higher than 8000ft, as these altitude and pressure changes can cause the lung to re-collapse if the lung is not yet healed.

A closed head injury is any injury to the head, closed implies that the object that struck the head does not go through the skull. Closed head injuries can range from a minor injury, to a devastating, life-threatening major injury.

Closed head injury can cause broken bones, such as the skull and the bones of the face, and can cause significant damage to the brain itself.The damage to the brain can be in the form of bruising of the brain (this is called a "Concussion") or can cause bleeding in or around the brain (this is called "Intracranial Hemorrhage" - meaning bleeding inside the skull).

Causes of closed head injury/ concussion

The most common causes of a closed head injury:

Falls, from height or just from standing can cause significant injuries

In children head injuries can be caused by child abuse situations (Shaken Baby Syndrome is an example of this).

Symptoms of a closed head injury/ concussion

Symptoms depend on the type of injury a person has and how severe it is. People with a mild closed head injury, such as a bump on the head, might not have any symptoms. Symptoms include:

A headache, could be just at the area of impact or over the entire head

Nausea or vomiting

Vision or hearing problems

Swelling, bleeding, or bruising on the scalp or around the face or eyes

Blood or clear fluid draining from inside the ears or the nose: this could be a sign of fractured skull

Dizziness or feeling lightheaded

Confusion or memory problems: some people can have trouble remembering just the accident, and in more severe cases they may have difficulty remembering things from before the accident

Difficulty concentrating on tasks or difficulty paying attention

Feeling tired

Mood or behavior changes, or feeling easily irritated

Difficulty walking, or difficulty keeping their balance

Difficulty speaking

Seizures – Seizures are waves of abnormal electrical activity in the brain. They can make you pass out, or move or behave strangely.

Passing out or losing consciousness

Being overly sensitive to bright lights or noises

Symptoms can start right after a closed head injury, or a few hours or days later. Some people have symptoms that last a short time only. Other people have symptoms that cause long-lasting problems, lasting for weeks to months after a head injury.

In cases of severe head injury, a person can be in a coma and may require mechanical life support.

**If you or someone you know has had a head injury and you have any of the symptoms listed above, you should seek medical attention immediately to look for more serious conditions.

Testing for closed head injury

If you have significant head injury, or the doctor suspects that you have any fractures, the doctor will want to do testing to evaluate for serious injuries. He or she will do an examination and will ask questions to check your thinking and your memory to test you for brain injury.

If your doctor is concerned that you may have a serious injury, he or she will likely order an imaging test of your brain, such as a CT or MRI scan. These tests create pictures of your skull and brain to evaluate for more serious conditions, such as bleeding in or around the brain, and any broken bones associated with the head injury.

In many cases of a concussion, the imaging will be normal, but the patient can still have significant symptoms.

Treatment for closed head injury

Treatment depends on your injury and how serious it is.

Hospital treatment - In people that are found to have more significant injury, such as those with findings of bleeding around the brain or skull or facial bone fractures, these patients are usually treated in the hospital. This is to allow doctors and nurses to closely observe patients for conditions that may be worsening.
If there is bleeding around the brain, this can continue to enlarge. If the brain is injured, it may swell, just like any other part of the body. However, the brain is surrounded by the hard skull which does not allow space for the blood or swelling; if there is blood around the brain or swelling of the brain, this can cause extreme pressure on the brain, which can cause permanent brain damage. Injury to the brain can also cause seizures, which in turn can cause more damage to the brain.
The length of stay in the hospital depends on the severity of the injury, as well as other compounding factors such as other injuries, age, and severity of symptoms.
Treatment will include brain rest with minimal brain stimulation, medications to prevent seizure, medications to help with the headaches (this is the most common symptoms after head injury), Physical and occupational therapy to assist with walking and balance, Speech therapists who specialized in the cognitive brain function (higher level thinking skills) to assist in regaining memory, speech, concentration, etc.
Patients may be treated in the Intensive Care Unit if they have significant injury or more serious symptoms. In cases of severe bleeding around the brain, a person may require surgery to open the skull and remove the blood around the brain to prevent further brain injury.

Home treatment - People whose symptoms go away after a short time can usually leave the hospital after a few hours. Usually, mild closed head injuries do not need treatment. The symptoms will resolve with time, but exactly how long that will take is different for every patient (can be days to weeks to months). Your doctor will tell you what medications you can take (or those to avoid) to help treat the symptoms.
The doctor will probably recommend that someone watch the patient at home for 24 hours to make sure their symptoms don’t get worse. If the symptoms get worse, that person needs to be brought to an Emergency room promptly. This person should watch for new symptoms or the symptoms listed above. If you fall asleep, he or she should wake you up every few hours to make sure that you can be woken up.
You should seek medical attention immediately if you have any of the following:

Your headache gets worse or you have any vision changes.

You are vomiting.

Your thinking or behavior changes, if you are becoming more confused.

You can’t walk or speak normally.

You have a seizure.

Plus, the person watching you should call the doctor or nurse if he or she can’t wake you up. This could be a sign that a more serious injury is developing.

Help your brain heal

To help your brain heal after a concussion, you can:

Rest your body – Make sure to get plenty of sleep. When you are awake, you should avoid heavy exercise or too much physical activity.

Take a pain-relieving medicine, if you have a headache – You can choose one with acetaminophen (sample brand name: Tylenol®) or ibuprofen (sample brand names: Advil®, Motrin®).

Recovery after closed head injury/ concussion

The severity of symptoms of a closed head injury or concussion can vary with each patient. Some people have mild symptoms with just a headache, and others have more significant symptoms. The symptoms generally will resolve on their own with time, but exactly how long that will take is different for every patient (can be days to weeks to months). Some of the symptoms may never go away entirely.

You will need to be cleared by your doctor before participating in any contact sports, or other activities that put you at risk of falling or injuring your head again, after you have a head injury. This will depend on your symptoms and the severity of the injury.

*It is very important to prevent head injuries in the future. After you have had a concussion, your brain is more sensitive, and a second (or more) head injury can cause more significant damage. The damage to the brain from head injuries is additive (meaning each time can be worse than the one before it). This can be a problem for people participating in sports, and having more than one concussion can be a reason for a doctor to recommend that the patients stops playing that sport all together.

To prevent future head injuries: You should wear a helmet when participating in any sports in which a helmet is available (football, hockey, skiing and snowboarding, horse-back riding, riding bicycle or motorcycle). Always wear a seat-belt when riding in a vehicle.

Chest injuries can cause a hemothorax, which is accumulation of blood in the chest cavity, in the space between the lung and the chest wall. This results from injuries to the lung tissue or from blood vessels that run alongside each rib. There can also be massive amount of bleeding from injury to the heart or major blood vessels around the heart. This can be diagnosed by either Chest X-ray or an ultrasound or a CT scan.

Treatment of hemothorax

Small, clinically insignificant collections may be observed and may not require treatment.

If your hemothorax is large or causing symptoms, your doctor will need to remove the blood that has collected outside of your lung. He or she can do this in different ways. It usually involves having your doctor make a small hole in between your ribs, and he or she will put a tube (this is called a Chest Tube) through the hole and into the collection of blood or fluid in the chest. The chest tube will stay in your chest for a few days, or more, until the drainage from the tube is slowed down adequately. It will be followed by Chest X-rays and examination. You will need to stay in the hospital while this tube is in your chest.

Surgery for hemothorax

Sometimes surgery is required to remove the blood from the chest cavity, if it is not able to be drained with the chest tube alone. If the blood has been in the chest for several days, it can become very thick (like pudding consistency); this cannot be drained with a tube alone, and may require surgery to remove the blood.

This surgery is called “thoracoscopy or VATS (Video-assisted Thoracic Surgery).” During thoracoscopy, the doctor will give you medicine to make you sleep; it will be done under general anesthesia. Then he or she will make 2 or 3 small cuts between the ribs in your chest. He or she will put long, thin tools in these openings and into the space between you lung and your ribs. One of the tools has a camera on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to do the surgery. This allows the doctor to clean out the inside of the chest. Sometimes this cannot be completed using thoracoscopy, and in some cases it will require open chest surgery (this is called thoracotomy) to clean out the fluid in your chest.

After surgery you will have one or more chest tubes in your chest to continue draining the fluid and blood from your chest. You will need to stay in the hospital for 3-7 days, or more, as you recover and while the chest tube is in place. The chest tube will be followed by examination and Chest X-rays.

The liver is a large organ that sits in the right upper abdomen, under the rib cage. It performs many essential functions of life. Unlike the spleen, a person cannot live without a liver.

Liver Injury

The liver is the most commonly injured organ in blunt abdominal trauma. Liver injury can be caused by a car/ bike/ motorcycle accident, or by a direct hit to the Right side, or a fall onto the Right side; injury to the liver can also be caused by broken ribs, which can puncture or tear the liver.

Ruptured or lacerated (torn) liver is an emergency as it can cause a significant amount of blood loss. If you have pain in your belly after an injury, you should go to the Emergency Room Promptly. You will likely have a CT scan of the abdomen to evaluate for liver injury.

You will likely need to be hospitalized so that the doctor can watch you closely for bleeding, and treat the bleeding promptly. Most liver injuries are relatively minor and heal on their own without the need for surgery. If the liver is bleeding and it does not stop on its own, you may need surgery to stop the bleeding. The doctor may try other methods, before surgery, to stop the bleeding. This is a procedure, usually done by a radiologist, in which the doctor will inject a contrast dye into the arteries to find the spot where the bleeding is coming from, and then intentionally “clot off” that artery to stop the bleeding. In rare cases, if the bleeding continues, the doctor will need to do surgery to stop the bleeding. This is a high-risk surgery that is generally only done in severely injured patients.

Recovery from liver injury

Liver injuries will be followed by CT scans of the abdomen to watch for healing or re-bleeding. You may be in the hospital for 2-7 days, or more, depending on the degree of injury to the liver, as well as other injuries that you may have.

**You will not be allowed to participate in any contact sports, or any activities (biking, skiing, snowboarding, skateboarding, horseback riding, etc) that put you at risk of falling or re-injuring your abdomen for at least 8 weeks while the liver heals. Re-injury can cause much more severe bleeding and complications than the first injury. Ask your doctor when you can resume your activities.

Pneumothorax is the medical term for a collapsed lung. This happens when air from the lung escapes out of the lung and builds up in the space between the lung and the chest wall (called the Pleural space); this puts pressure on the lung and causes it to collapse. This is a common complication of blunt trauma to the chest, often sustained from a fractured rib. Sometimes people can have a collapsed lung without rib fractures, from the force of the impact on the chest, forces air out of the lung.

Pulmonary contusion is a bruise of the lung itself. It is another common consequence of blunt chest injury, such as from a fall or a car accident. It may be associated with Rib fractures, but can also be present without any rib fractures. Pulmonary contusions generally develop over the first 24-48 hours after injury and resolve in about one week. This may show up as an abnormal area of the lung on Chest X-ray or CT scan.

Treatment involves treating the patients pain adequately so that they are able to take deep breaths and cough. Treating the pain is important, because when people have rib pain, they try to keep their ribs from moving too much. Then they don’t breathe in and out as deeply as they should. When people don’t breathe in and out as deeply as they should, some of the small airways in the lungs can close off. This raises the chances of getting a lung infection, called pneumonia, especially when the lung is bruised as this creates an even higher risk of pneumonia.

Patients with numerous rib fractures and lung contusion may need to be hospitalized for 2-7 days or more to allow adequate recovery and to be closely observed by a doctor. Your doctor will also recommend a treatment to help prevent your small airways from closing off. This treatment, called “incentive spirometry,” involves breathing deeply into a hand-held device a number of times each day. It is also very important that you do not stay in bed. Activity, such as walking, although it can be painful, is very important to keep good lung function and to prevent pneumonia. Once you are sent home from the hospital, you should walk around your house several times per day, and increase your activity as you can tolerate.

People who have severe or numerous rib fractures, with severe pulmonary contusions may not be able to breathe on their own and sustain their body’s oxygen needs, and may require a ventilator to help them breath.

A “fracture” is another word for a broken (or cracked) bone; these all have the same meaning. A rib fracture is when a person breaks a rib bone, the bone of the rib cage.

Most rib fractures happen after a direct injury to the chest, often from a fall, or a car accident. Coughing hard can also cause rib fractures. Injuries significant enough to break ribs can also cause damage to organs in the chest or belly, such as the lung, liver or spleen. One or more ribs may be broken on one or both sides of the chest (you have 12 ribs on each side).

Some rib fractures, called “stress fractures,” do not happen after an injury. Instead, they are caused by a severe cough or a motion people do over and over, like swinging a golf club.

Skull and facial fractures are terms for any broken bones of the skull (all the bones surrounding the brain and organs of the head) and the face (there are numerous small bones that make up the face), resulting from an injury to the head or face.

Head injuries that are significant enough to cause broken bones many times will result in injury to the brain as well. However, people can have injury to the brain (a Concussion or bleeding around the brain) without having any broken bones.

Facial or skull fractures can involve the bones around the eye (the eye socket), the nose and sinuses, the cheek bones, and the upper and lower jaw (including the teeth). People can have fractures of one or multiple bones. Some fractures, if they are displaced (meaning the 2 ends of the broken bone are moved out of their normal position) may need surgery to fix the broken bones. Sometimes the fractures are on the outside (like the nose or jaw) and sometimes fractures are on the inside of the skull and are not directly visible.

Causes of Skull and Facial Fractures

Skull and facial fractures can happen when people are hit hard on their head or face.

Common causes include falls (either from a height or from standing), car accidents, and sports injuries.

Serious Complications from Skull and facial fractures include:

Brain damage, Concussion (bruising of the brain) or bleeding around the brain

An infection of the tissues around the brain and spinal cord (called meningitis)

Seizures – Seizures are waves of abnormal electrical activity in the brain. They can make people pass out, or move or behave strangely.

Injury to the eyeball or the muscles that move the eye

Sinus infections

Symptoms of a Skull or Facial Fractures

Symptoms can be mild or severe, depending on where the fracture is and how serious it is. Possible symptoms can include:

Pain, swelling, bleeding, or bruising around the face – Sometimes, it takes a day for the swelling to start

A headache

Feeling very tired, confused, or dizzy

Bruising around the eyes, or behind the ear

Bleeding from the nose or ear

Clear fluid draining from the nose or ear – This is spinal fluid, the fluid that surrounds the brain and spinal cord, and could be a sign of internal fractures

Vomiting

Trouble smelling, hearing, or seeing

Weakness or numbness of the face

Testing for a Skull or Facial Fracture

If you have significant head injury, or the doctor suspects that you have any fractures, the doctor will want to do testing to evaluate for serious injuries. He or she will do an examination and will ask questions to check your thinking and your memory to test you for brain injury.

If your doctor is concerned that you may have a serious injury, he or she will likely order an imaging test of your brain, such as a CT or MRI scan. These tests create pictures of your skull and brain to evaluate for more serious conditions, such as bleeding in or around the brain, and any broken bones associated with the head injury.

Treatment of Skull and Facial Fractures

Treatment depends on the type of fracture and where it is.

In most cases, patients will be seen by an Ears, Nose, Throat Specialist (called an Otolaryngologist) to determine if the fractures need to be fixed with surgery.

Many people will not need any treatment. If the skull bone only cracks but doesn’t move out of place, people usually don’t need treatment. But their doctor will watch them to follow their symptoms.

Some patients may need to have surgery to fix the broken bones; these can include:

Patients who have broken bones that are displaced (meaning the 2 ends of the broken bone are moved out of their normal position)

Fractures involving an open wound (meaning there is a break in the skin near the fractured bone): this can cause a severe infection

Fractures involve the eyeball

Fractures of the jaw

Fractures that are cosmetically disfiguring

People with significant head injury may need to be hospitalized to watch closely for more serious conditions.

How to help prevent skull and facial fractures

To help prevent skull and facial fractures, people can:

Wear a HELMET every time they ride a bike or motorcycle, or play high-risk sports (football, hockey, etc.).

Splenectomy removes the entire spleen. This is typically done for splenic injury with uncontrollable bleeding, or for certain diseases that cause splenomegaly (enlarged spleen) to prevent rupture of the spleen. If splenectomy is done for trauma or injury, the surgery will usually be done as an emergency open surgery, in order to evaluate for other injuries inside the belly.

During surgery, the spleen is pulled gently off the outer abdominal wall and the surrounding structures; the arteries and the veins providing the blood supply to the spleen are tied off and cut and the entire spleen is removed. Once the spleen is removed, the area is examined for bleeding.

The spleen is an organ located in the upper left side of the abdomen that filters bacteria from the bloodstream and is important for fighting infections; it works as part of the immune system. The spleen also removes damaged red blood cells from the bloodstream.

Traumatic splenic rupture/ laceration

Blunt abdominal trauma, especially trauma to the Left side of the abdomen, many times results in injury to the spleen, which causes pain in the abdomen and bleeding from the spleen. This can be caused by a car/ bike/ motorcycle accident, or by a direct hit to the Left side, or a fall onto the Left side; injury to the spleen can also be caused by broken ribs, which can puncture or tear the spleen. Rupture of the spleen sometimes can occur several days or weeks after the initial injury, which can cause severe pain in Left upper abdomen.

Ruptured or lacerated (torn) spleen is an emergency as it can cause a significant amount of blood loss. If you have pain in your belly after an injury, you should go to the Emergency Room Promptly. You will likely have a CT scan of the abdomen to evaluate for a spleen injury.

You will likely need to be hospitalized so that the doctor can watch you closely for bleeding, and treat the bleeding promptly. Sometimes the spleen will bleed a small amount and then stop on its own; in this case you may not need surgery. If the bleeding does not stop on its own, you may need to have surgery to remove the spleen to stop the bleeding from the spleen (this is called a “Splenectomy”). The doctor may try other methods, before surgery, to stop the bleeding. This is a procedure, usually done by a radiologist, in which the doctor will inject a contrast dye into the arteries to find the spot where the bleeding is coming from, and then intentionally “clot off” that artery to stop the bleeding.

Recovery from Spleen Injury

Spleen injury will be followed with CT scans of the abdomen to watch for healing or re-bleeding. You may be in the hospital for 2-7 days, or more, depending on the degree of injury to the spleen, as well as other injuries that you may have.

**You will not be allowed to participate in any contact sports, or any activities (biking, skiing, snowboarding, skateboarding, horseback riding, etc) that put you at risk of falling or re-injuring your abdomen for at least 8 weeks while the spleen heals. Re-injury can cause much more severe bleeding and complications than the first injury. Ask your doctor when you can resume your activities.

Sternal fracture (fracture of the breast bone) usually result from a high-energy direct blow to the front of the chest wall. Typically these fractures occur during a motor vehicle crash when the driver's chest strikes the steering column or rapid stopping causes an occupant's chest to slam against their cross-shoulder seatbelt. Common associated injuries include: rib fractures, myocardial contusion (bruising of the heart), spinal fracture, hemothorax, and pneumothorax.

No specific treatment is usually needed. Pain control is very important to prevent pneumonia similar to rib fractures. Your doctor will also recommend a treatment to help prevent your small airways from closing off. This treatment, called “incentive spirometry,” involves breathing deeply into a hand-held device a number of times each day. It is also very important that you do not stay in bed. Activity, such as walking, although it can be painful, is very important to keep good lung function and to prevent pneumonia. When you are sent home from the hospital, you should walk around your house several times per day, and increase your activity as you can tolerate.

Our facilities do not discriminate against any person on the basis of race, color, national origin, disability, or age in admission or access to, or treatment or employment in, its programs, services or activities, or on the basis of sex (gender) in health programs and activities. Read the full notice: Saint Joseph Hospital Notice of Nondiscrimination